Provider Demographics
NPI:1184999237
Name:MATAVA-KUZMA, KATHLEEN LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:MATAVA-KUZMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 LAKE PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-2527
Mailing Address - Country:US
Mailing Address - Phone:814-825-2103
Mailing Address - Fax:
Practice Address - Street 1:10011 LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-2527
Practice Address - Country:US
Practice Address - Phone:814-825-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL1661991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse